Clinical condition of teeth and dentition in children and adolescents with cerebral palsy

BACKGROUND: Literature and statistical data reveal the increasing incidence of psychoneurological diseases (PND) and thus dental pathologies with PND in children and adolescents. Thus, the authors examined the structures and frequency of dental defects and deformities in patients with PND. Children and adolescents with PND aged 7–18 years are at high risk for the development of dental pathologies, and oxidative stress and immune system disorder present major associations with the pathogenesis of dental pathologies.

AIM: To determine the structure and frequency of dental defects and deformities in children and adolescents with PND and study the etiopathogenetic factors and mechanism of pathology formation to guide the development of preventive measures.

MATERIAL AND METHODS: The study comprehensively analyzed the data of 299 patients aged 7–18 years, of which 143 were diagnosed with PND based on the International Classification of Disease 10th Revision (main group; МG) and 156 somatically healthy patients with dental pathologies (control group; CG). The participants were divided into two subgroups: 75 patients aged 7–12 years (52.44%; МG-1) and 68 patients aged 13–18 years (47.55%; МG-2) from the main group (MG) and 65 (41.66%; CG-1) and 91 (58.33%; CG-2) patients from the CG of the respective age groups.

RESULTS: The incidence rates of caries in the temporary teeth of MG-1 and CG-1 were 97.33% and 84.61% and in the permanent teeth of MG-2 and CG-2 were 95.58 and 87.91%, respectively. In the pre-eruptive period, the rates of dental lesions were as follows: hypoplasia, 20.97%; impaired dentition, 49.65%; primary adentia, 47.55%; anomalies of the completeness of teeth, 64.33%; endemic fluorosis of teeth, 2.79% in patients with PND; and 12.17%, 12.17%, 26.92%, 11.53%, and 0.6% in children and adolescents in CG, respectively (p < 0.0001): disappearance of dental hard tissues, 9.09%; dental injuries, 24.47%; enamel necrosis, 7.7%; enamel erosion, 17.5% of patients with MG. In children and adolescents of CG, only tooth trauma was noted in 7.7% and enamel necrosis in 1.3%. In patients with PND, 49.6% had distal occlusion; 37.8%, cross occlusion; 31.6%, neutral occlusion; 29.9%, deep incisor occlusion; 25.9%, deep incisor malocclusion; 54.5%, narrowing of the lower dentition; 43.3%, crowding of teeth in the lower jaw; 26.6%, diastemas; and tremas, 23.8%.

CONCLUSION: Non-carious lesions of the teeth and a shift in the timing of the development of temporary and permanent teeth are more common in MG than in CG and lead to impaired dental anatomy and disrupt the aesthetics of smiles, speech, etc. Moreover, hypertrophic gingivitis and local periodontitis were characteristic of children with severe PND, who are at high risk for dental pathologies associated with oxidative stress and genetically related immune system disorders, especially in older children with PND.